ABSTRACT
Antecedentes: El embarazo de gemelos monocoriales tienen un mayor riesgo de mortalidad y morbilidad perinatal, que la gestación única y el embarazo gemelar bicorial. Objetivos: Estudiar la incidencia y el manejo de las complicaciones fetales propias de las gestaciones gemelares monocoriales biamnióticas. Métodos: Se realizó un análisis retrospectivo de 94 embarazos gemelares monocoriales biamnióticos, seguidos en las Consultas de Tocología de Alto Riesgo del Hospital Universitario La Paz de Madrid, entre 2008 y 2010. Resultados: Se recogieron 94 gestaciones monocoriales biamnióticas. Aparecieron complicaciones fetales en el 23,4 por ciento de las mismas: síndrome de transfusión feto-fetal en el 9,57 por ciento de los casos, retraso del crecimiento intrauterino selectivo en el 11,7 por ciento, muerte fetal intrauterina en el 2,1 por ciento, y malformaciones fetales en el 7,4 por ciento. Conclusiones: Las gestaciones monocoriales biamnióticas son un tipo de embarazo gemelar de alto riesgo, asociado con más complicaciones fetales y muerte perinatal. Se recomienda un estrecho seguimiento ecográfico cada 2 semanas, desde la semana 16, para diagnosticar y tratar precozmente las complicaciones fetales.
Background: The monochorionic twin pregnancy has a higher risk of perinatal mortality and morbidity, than the single gestation and the dichorionic twin gestation. Objectives: To detail the incidence and management of specific fetal complications of monochorionic diamniotic twin pregnancies. Methods: We performed a retrospective analysis of monochorionic diamniotic pregnancies followed in the High Risk Obstetrics Unit of the University Hospital La Paz, Madrid, between 2008-2010. Results: We collected 94 monochorionic diamniotic pregnancies. Fetal complications occurred in 23.4 percent of them: feto-fetal transfusion syndrome in 9.57 percent of cases, selective intrauterine growth retardation in 11.7 percent, stillbirth in 2.1 percent, and fetal malformations in 7.4 percent. Conclusions: Monochorionic diamniotic twin pregnancies are a high-risk type of twin pregnancy, associated with an increased risk of death and perinatal complications. Ultrasound monitoring is recommended for uncomplicated monochorionic pregnancies every 2 weeks from week 16, to detect and treat fetal complications.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnancy, Multiple , Diseases in Twins/epidemiology , Diseases in Twins , Twins , Amnion , Congenital Abnormalities/epidemiology , Congenital Abnormalities/therapy , Chorion , Maternal Age , Pregnancy, High-Risk , Retrospective Studies , Incidence , Fetal Death , Fetal Growth Retardation/epidemiology , Fetal Growth Retardation/therapy , Fetofetal Transfusion/epidemiology , Fetofetal Transfusion/therapy , Ultrasonography, PrenatalABSTRACT
Presentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos.
We describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severetwin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discre-pancies in the hemoglobin levéis between the twins, with no differences in blood volume.
Subject(s)
Humans , Female , Pregnancy , Adult , Polycythemia/diagnosis , Polycythemia/etiology , Laser Therapy/adverse effects , Anemia/diagnosis , Anemia/etiology , Polycythemia/therapy , Laser Coagulation/adverse effects , Fetal Diseases/diagnosis , Fetal Diseases/etiology , Fetal Diseases/therapy , Fetofetal Transfusion/therapy , Fetoscopy , Pregnancy, Twin , Anemia/therapyABSTRACT
A síndrome de transfusão feto-fetal (STFF) é uma das complicações mais graves que pode ocorrer em gestações gemelares monocoriônicas. Sua incidência varia de 1:40 a 1:60 em gestações gemelares e de 10 a 20 das gemelares monocoriônicas. Sua fisiopatologia é explicada pelo desequilíbrio das anastomoses vasculares placentárias e a resposta cardiovascular a essa alteração. A taxa de mortalidade sem tratamento é de 70 a 100 para pelo menos um dos gêmeos e não existe consenso bem definido sobre qual o melhor momento para se realizar o tratamento nem sobre a técnica a ser utilizada.
Twin-twin transfusion syndrome (TTTS) is one of the most serious complications that can occur in monochorionic twin pregnancies. The incidence of TTTS ranges from 1:40 to 1:60 in twin pregnancies and 10-20 in monochorionic twin pregnancies. The pathophysiology of the disease is explained by the imbalance of placental vascular anastomoses and the cardiovascular response to this alteration. The mortality rate without treatment is 70-100 for at least one of the twins and there is no clear consensus about the best time to perform the treatment or wich technique shoud be used.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Fetofetal Transfusion/physiopathology , Fetofetal Transfusion/therapy , Fetofetal Transfusion/classification , Fetofetal Transfusion/diagnosisABSTRACT
Acardiac twin is a rare event with high perinatal mortality rate and the management strategies remain controversial. The authors report 4 cases of twin pregnancies associated with one acardiac twin diagnosed at King Chulalongkorn Memorial Hospital during the period 1993 to 2002. Two cases were expectantly managed and intrauterine interventions were performed in order to occlude umbilical artery of the acardiac twin in 2 cases, by using Guglielmi detachable coil (GDC) embolization and absolute alcohol injection. Overall, the perinatal mortality rate for the pump twin was 50% and the survival rate of expectant management in the present series was 100%. GDC embolization was judged to be technically successful since it completely occluded the circulation to the acardiac twin. However, the pump twin was dead which might have resulted from the compromised state due to cardiac failure. At present, it seems that conservative management with close antenatal surveillance is the treatment of choice when the twin-weight ratios are substantially less than 70%. Invasive techniques should be considered when there is ultrasound evidence of hydramnios or congestive heart failure of the pump twin at a previable gestational age.
Subject(s)
Adult , Diseases in Twins/therapy , Ethanol/therapeutic use , Female , Fetal Death/etiology , Fetal Heart/abnormalities , Fetal Weight , Fetofetal Transfusion/therapy , Humans , Pregnancy , Pregnancy Outcome , ThailandABSTRACT
El síndrome de transfusión intergemelar severo sin tratamiento presenta una mortalidad virtual de 100 por ciento en ambos fetos. Se han descrito múltiples opciones terapéuticas para esta entidad. La fotocoagulación láser de las anastomosis placentarias intergemelares es la única terapia capaz de revertir el síndrome preservando la vida de los fetos. Presentamos un caso de síndrome de transfusión intergemelar estadio III con severas complicaciones maternas en el cual se realizó fotocoagulación láser selectiva de los vasos comunicantes: Discutimos la utilidad de ésta y otras alternativas terapéuticas.
Subject(s)
Humans , Female , Pregnancy , Fetoscopy , Light Coagulation , Fetofetal Transfusion/surgery , Fetofetal Transfusion/diagnosis , Fetofetal Transfusion/therapy , Venezuela , Gynecology , ObstetricsSubject(s)
Humans , Female , Pregnancy , Fetal Blood , Fetus , Pregnancy Complications , Fetofetal Transfusion/diagnosis , Fetofetal Transfusion/physiopathology , Fetofetal Transfusion/therapy , Fetofetal Transfusion , Twins, Monozygotic , Ultrasonography, Prenatal , Diagnosis, Differential , Fetal Viability , Gestational Age , Laser-Doppler Flowmetry , Placenta , Pregnancy Trimester, SecondABSTRACT
Os autores relatam um caso de síndrome de transfusão feto-fetal ocorrido em uma paciente do Ambulatório de Ginecologia e Obstetrícia do Hospital Universitário São Francisco. A paciente procurou o serviço com diagnóstico de gemelaridade e aumento excessivo de volume abdominal. A ultra-sonografia obstétrica evidenciou gestação gemelar com um dos fetos apresentando polidrâmnio acentuado e o outro com oligoâmio. Instalou-se a terapêutica a fim de melhorar as condições fetais e postergar o término da gravidez, porém sem sucesso, evoluindo ambos para óbito
Subject(s)
Humans , Pregnancy , Female , Fetofetal Transfusion/diagnosis , Fetofetal Transfusion/physiopathology , Fetofetal Transfusion/therapyABSTRACT
Se realiza un análisis del síndrome de transfusión feto-fetal y se expone un caso clínico que finalizó en mortinato, demostrándose la gravedad y complejidad de esta patología. se destacan las características clínicas patogénicas, alternativas diagnósticas y eventuales opciones terapéuticas con sus respectivos riesgos, se hace referencia a las múltiples y graves complicaciones post natales